Air Flow Cooling Improves Anterolateral Thigh Perforator Mapping Using the FLIR ONE Thermal Camera

Area of Science:

• Plastic Surgery
• Microsurgery
• Surgical Anatomy

Background:

• Preoperative perforator mapping is crucial for anterolateral thigh (ALT) free flap harvesting due to variable vascular anatomy.
• Dynamic infrared imaging offers a non-invasive method to visualize angiosomes and assist in preoperative planning.
• Standardized protocols are needed to optimize ALT perforator planning using thermal imaging.

Purpose of the Study:

• To compare different precooling methods for dynamic infrared perforator imaging.
• To develop a standardized and simplified protocol for ALT perforator planning.
• To evaluate the efficacy of thermal imaging in conjunction with Doppler ultrasonography.

Main Methods:

• Fifty thighs were examined using a FLIR ONE thermal camera.
• Four precooling methods were compared: alcoholic disinfection, wet sponge cooling, fan cooling, and cold pack application.
• Thermographic hot spot locations were compared to Doppler ultrasonography findings in a double-blinded manner.

Main Results:

• The overall matching rate between thermographic hot spots and perforators was 34.9%.
• This rate increased to 62.2% when considering only clinically relevant perforators (e.g., larger diameter, specific course).
• Fan cooling followed by alcoholic disinfection yielded the clearest thermograms and fastest results.

Conclusions:

• Dynamic infrared imaging is a reliable adjunct to ultrasound for perforator imaging.
• Simplified precooling methods like fan cooling or alcoholic disinfection enhance thermogram quality.
• Focusing on clinically relevant perforators improves the accuracy of thermal mapping, reducing distraction from non-essential vessels.